A CLINICAL COMPARATIVE STUDY OF 8 mg AND 10 mg OF 0.5% HYPERBARIC BUPIVACAINE AND COMBINATION OF EACH WITH 12.5 µg OF FENTANYL FOR SPINAL ANAESTHESIA IN CAESAREAN SECTION

Introduction:Spinal anaesthesia is commonly employed for caesarean delivery. Bupivacaine is the commonly used local anaesthetic for caesarean delivery. Intrathecal Bupivacaine alone may be insufficient to provide complete analgesia despite the high sensory block. The use of neuraxial opioids has gained popularity over the last few years they may augment the analgesia produced by local anaesthetic through direct binding with the specific spinal receptors. Hence the present study was done to compare the synergistic effect of intrathecally administered Fentanyl 12.5 micrograms with 8 mg and 10 mg of 0.5% hyperbaric Bupivacaine on sensory and motor block characteristics, recovery profile and also quality of intraoperative and postoperativeanalgesia.

Methods:One hundred twenty patients belonging to ASA class I and II with singleton pregnancy with term gestation posted for caesarean section, who have no contraindication for spinal anaesthesia were selected. They were randomly divided into four groups of 30 patients each.

Results:Onset of sensory and motor block were similar in low dose of 0.5% hyperbaric Bupivacaine (8 mg) alone and 0.5% hyperbaric Bupivacaine(8 mg) and Fentanyl(12.5µg) combination groups. However it increased with increasing doses of 0.5% hyperbaric Bupivacaine (10 mg) alone and in 0.5% hyperbaric Bupivacaine (10 mg) and Fentanyl (12.5µg) combination groups.Total duration of analgesia (time from injection of drug to first requisite for analgesics) lasted longer in group IV (257.03±8.46) and group III (206.00±11.80) when compared to group II (166.66±7.00) and group I (143.96±7.25). Quality of anaesthesia was excellent in all the groups. The intraoperative haemodynamic changes were similar in all the groups. Incidences of other side effects were not significant among the groups. The addition of Fentanyl to Bupivacaine significantly delayed the postoperative pain and sensory recovery but motor recovery time did not change with addition of Fentanyl.

Conclusion:Addition of fentanyl to bupivacaine improved the quality of intraoperative anaesthesia and prolonged the postoperative analgesia

and also decreased the dose of Bupivacaine. However Bupivacaine 8 mg and 10 mg can also be safely used for spinal anaesthesia in caesarean delivery with lesser duration of postoperative analgesia.